CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS
a campus of the California State University ▪ Bakersfield ▪ Channel Islands ▪ Chico ▪ Dominguez Hills ▪ Fresno ▪ Fullerton ▪ Hayward ▪ Humboldt ▪ Long Beach ▪ Los Angeles
Maritime Academy ▪ Monterey Bay ▪ Northridge ▪ Pomona ▪ Sacramento ▪ San Bernardino ▪ San Diego ▪ San Francisco ▪ San Jose ▪ San Luis Obispo ▪ San Marcos ▪ Sonoma ▪ Stanislaus
RELEASE OF LIABILITY, WAIVER OF RIGHT TO SUE, ASSUMPTION OF RISK AND
AGREEMENT TO PAY CLAIMS
Activity:
Activity Date(s) and Time(s):
Activity Location/Facility:
In consideration for being allowed to participate in this Activity, I release from liability and waive my right to
sue the State of California, the Trustees of the California State University, which own and operate California
State University, Channel Islands and their employees, officers, volunteers and agents (collectively
“University”) from any and all claims, including the University's negligence, resulting in any physical injury,
illness (including death) or economic loss that I may suffer because of my participation in this Activity,
including any travel to and from the Activity.
I am voluntarily participating in this Activity. I understand that there are risks, such as physical and/or
psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability or even death,
which may occur from my participation in this Activity. These injuries or outcomes may arise from my own or
other's actions, inactions, negligence, or from the condition of the Activity location(s) or facility(ies).
Nonetheless, I assume all related risks, whether known or unknown to me, of my participation in this
Activity, including travel to and from the Activity.
I agree to hold the University harmless from any and all claims, loss or damage to my personal property,
liabilities and costs, including attorney's fees, as a result of my participation in this Activity, including travel
to and from the Activity. If the University incurs any of these types of expenses, I agree to reimburse the
University.
If I need medical treatment, the University is authorized to obtain medical treatment for me. I will be financially
responsible for any costs of such treatment. I agree that I will not hold the University responsible for any claims
resulting from any medical treatment. I am aware that the University does not provide health insurance for me
and I should carry my own health insurance.
I am 18 years or older. I have read this document, and I am signing it freely. I understand the legal
consequences of signing this document, including (a) releasing the University from all liability, (b) waiver
of my right to sue the University, (c) and assumption of all risks of participating in this Activity, including
travel to and from the Activity.
I understand that this document is written to be as broad and inclusive as legally permitted by the State of
California. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the
remaining terms.
Participant Name: Date:
Signature:
One University Drive
Camarillo, California 93012
Tel 805-437-8400
Fax 805-437-8424
